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Kinoshita N, Shima T, Terasaki K, Oya H, Katayama T, Matsumoto J, Mitsumoto Y, Mizuno M, Mizuno C, Hirohashi R, Sakai K, Okanoue T. Comparison of thrombocytopenia between patients with non-alcoholic fatty liver disease and those with hepatitis C virus-related chronic liver disease. Hepatol Res 2022; 52:677-686. [PMID: 35543116 DOI: 10.1111/hepr.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 02/08/2023]
Abstract
AIM Thrombocytopenia is widely recognized as a simple surrogate marker of liver fibrosis in non-alcoholic fatty liver disease (NAFLD). Thrombocytopenia of NAFLD has not been compared with that of hepatitis C virus-related chronic liver disease (CLD-C). Here, we examined whether there is any difference in the platelet counts between patients with NAFLD and CLD-C and investigated the underlying mechanisms. METHODS A total of 760 biopsy-confirmed NAFLD and 1171 CLD-C patients were enrolled. After stratification according to the liver fibrosis stage, platelet counts between NAFLD and CLD-C patients were compared. The platelet count, spleen size, serum albumin level, serum thrombopoietin level, and immature platelet fraction (IPF) value were also compared after covariate adjustment using propensity score (PS) matching. RESULTS The median platelet counts (×104 /μL) of NAFLD and CLD-C patients were 20.2 and 18.7 (p = 2.4 × 10-5 ) in F1; 20.0 and 14.5 (p = 2.1 × 10-12 ) in F2; 16.9 and 12.3 (p = 8.1 × 10-10 ) in F3; and 11.1 and 8.1 (p = 0.02) in F4, respectively. In the F3 group, NAFLD patients had a significantly higher platelet count and significantly smaller spleen volume than CLD-C patients. Although the serum thrombopoietin levels were comparable between NAFLD and CLD-C patients, the IPF value of NAFLD patients was significantly higher than that of CLD-C patients. CONCLUSIONS NAFLD patients had a significantly higher platelet count than CLD-C patients following stratification according to the liver fibrosis stage. The milder hypersplenism and higher platelet production in NAFLD than CLD-C may have contributed to this difference.
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Affiliation(s)
- Naohiko Kinoshita
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan.,Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Kei Terasaki
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Takayuki Katayama
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Junko Matsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Yasuhide Mitsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Chiemi Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | | | - Kyoko Sakai
- Clinical Laboratory, Saiseikai Suita Hospital, Suita, Japan.,Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
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2
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Terasaki K, Mizuno C, Fujiishi S, Amioka S, Nonaka T, Itani J, Takahashi Y, Miura T, Yasufuku T, Oya H, Katayama T, Okuda K, Matsumoto J, Mitsumoto Y, Sawai N, Mizuno M, Shima T, Okanoue T. Garcin Syndrome Due to Meningeal Carcinomatosis from Gastric Cancer. Intern Med 2021; 60:855-858. [PMID: 33087672 PMCID: PMC8024967 DOI: 10.2169/internalmedicine.5797-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 58-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy showed an esophagogastric junction tumor with multiple duodenal intramural metastases, and computed tomography showed peritoneal metastasis. In the middle of her fourth cycle of chemotherapy, she displayed symptoms of a left-sided multi-cranial nerve palsy. She was diagnosed with Garcin syndrome caused by meningeal carcinomatosis from gastric cancer based on the results of gadolinium-enhanced brain magnetic resonance imaging and cytology of the cerebrospinal fluid. It is important not to overlook meningeal irritation symptoms or paralysis of cranial nerves and to consider the possibility of Garcin syndrome caused by meningeal carcinomatosis.
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Affiliation(s)
- Kei Terasaki
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Chiemi Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Shinsaku Fujiishi
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Shohei Amioka
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Takahiro Nonaka
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Junichiro Itani
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Yusuke Takahashi
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Takahiro Miura
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Tomoko Yasufuku
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Takayuki Katayama
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Kotaro Okuda
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Junko Matsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Yasuhide Mitsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Naoki Sawai
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
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Shima T, Ohtakaki Y, Kikuchi H, Uchino H, Isomura M, Aoyagi K, Oya H, Katayama T, Mitsumoto Y, Mizuno M, Umemura A, Yamaguchi K, Itoh Y, Okanoue T. A novel rapid immunoassay of serum type IV collagen 7S for the diagnosis of fibrosis stage of nonalcoholic fatty liver diseases. Hepatol Res 2021; 51:263-276. [PMID: 33350036 DOI: 10.1111/hepr.13605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
AIM Type IV collagen 7S (T4C7S) is a valuable biomarker for detecting liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). The conventional T4C7S measurement via radioimmunoassay (T4C7S RIA) has shortcomings of radioisotope usage and longer assay periods. We compared T4C7S RIA with a newly developed, fast T4C7S chemiluminescent enzyme immunoassay (T4C7S CLEIA) and examined the diagnostic accuracies of and correlation between the two techniques. METHODS We evaluated 170 biopsy-confirmed patients with NAFLD. T4C7S was measured via both T4C7S RIA and T4C7S CLEIA. The correlation between T4C7S RIA and T4C7S CLEIA was analyzed in 305 total serum samples via exploratory research and 47 validation samples. The diagnostic accuracies of T4C7S CLEIA and T4C7S RIA were compared in the sera of patients with NAFLD and test samples. RESULTS Sera T4C7S levels of T4C7S CLEIA and T4C7S RIA significantly correlated in patients' samples via exploratory (r = 0.914, P = 0.000) and validation (r = 0.929, P = 0.000) research. At a 10% coefficient, T4C7S CLEIA concentration was 0.26 ng/ml in the serum samples, indicating high accuracy at even low concentrations. T4C7S CLEIA revealed distinct changes between each stage and high sensitivity in detecting the F2 stage, indicating a higher sensitivity in detecting low fibrosis stages than T4C7S RIA in patients with NAFLD. CONCLUSIONS The T4C7S CLEIA correlated well with the T4C7S RIA. Favorably, the T4C7S CLEIA has a higher sensitivity and rapid measurement time and requires a small sample volume; thus, it is a promising and popular biomarker for fibrosis stage diagnosis in NAFLD.
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Affiliation(s)
- Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | | | | | | | | | | | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Takayuki Katayama
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Yasuhide Mitsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Atsushi Umemura
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kanji Yamaguchi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
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Thompson WH, Nair R, Oya H, Esteban O, Shine JM, Petkov CI, Poldrack RA, Howard M, Adolphs R. A data resource from concurrent intracranial stimulation and functional MRI of the human brain. Sci Data 2020; 7:258. [PMID: 32759965 PMCID: PMC7406507 DOI: 10.1038/s41597-020-00595-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 11/08/2022] Open
Abstract
Mapping the causal effects of one brain region on another is a challenging problem in neuroscience that we approached through invasive direct manipulation of brain function together with concurrent whole-brain measurement of the effects produced. Here we establish a unique resource and present data from 26 human patients who underwent electrical stimulation during functional magnetic resonance imaging (es-fMRI). The patients had medically refractory epilepsy requiring surgically implanted intracranial electrodes in cortical and subcortical locations. One or multiple contacts on these electrodes were stimulated while simultaneously recording BOLD-fMRI activity in a block design. Multiple runs exist for patients with different stimulation sites. We describe the resource, data collection process, preprocessing using the fMRIPrep analysis pipeline and management of artifacts, and provide end-user analyses to visualize distal brain activation produced by site-specific electrical stimulation. The data are organized according to the brain imaging data structure (BIDS) specification, and are available for analysis or future dataset contributions on openneuro.org including both raw and preprocessed data.
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Affiliation(s)
- W H Thompson
- Department of Psychology, Stanford University, Stanford, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - R Nair
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - H Oya
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - O Esteban
- Department of Psychology, Stanford University, Stanford, USA
| | - J M Shine
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - C I Petkov
- Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - R A Poldrack
- Department of Psychology, Stanford University, Stanford, USA
| | - M Howard
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - R Adolphs
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.
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5
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Shima T, Sakai K, Oya H, Katayama T, Mitsumoto Y, Mizuno M, Kanbara Y, Okanoue T. Diagnostic accuracy of combined biomarker measurements and vibration-controlled transient elastography (VCTE) for predicting fibrosis stage of non-alcoholic fatty liver disease. J Gastroenterol 2020; 55:100-112. [PMID: 31538241 DOI: 10.1007/s00535-019-01626-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous biomarkers have been developed for assessing the presence and severity of liver fibrosis associated with non-alcoholic fatty liver disease (NAFLD). Fibrosis can be assessed by liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE). Here we examined whether diagnostic accuracy and applicability can be further improved by combining various biomarker measurements with LSM. METHODS A total of 278 patients with biopsy-confirmed Japanese NAFLD patients were enrolled. Area under the receiver operator characteristic curve (AUROC) was evaluated for obtaining the optimum interpretation criteria for LSM by VCTE and comparing various biomarkers alone and in combination with LSM. RESULTS Liver stiffness measurements including cases with interquartile range (IQR)/median (M) < 30% or LSM ≤ 7.1 kPa demonstrated high applicability (90% of patients with NAFLD) and accuracy (AUROC: 0.891) for predicting stage ≥ 3 fibrosis. For all biomarkers tested, the AUROC values for predicting stage ≥ 3 fibrosis were increased when combined with LSM [platelet count, 0.734 vs. 0.912; type-4 collagen 7s (T4C7s), 0.894 vs. 0.921; aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), 0.774 vs. 0.906; AST to platelet ratio index, 0.789 vs. 0.902; FIB-4 index, 0.828 vs. 0.922; NAFLD fibrosis score, 0.800 vs. 0.906; CA index-fibrosis, 0.884 vs. 0.913; FM-fibro index, 0.920 vs. 0.943; FIB-4 index + T4C7s, 0.901 vs. 0.930], demonstrating the advantage of concurrent LSM. CONCLUSIONS While VCTE has slightly limited applicability (90%) for patients with NAFLD, concurrent measurement with certain biomarkers (especially FM-fibro, T4C7s, and FIB-4) greatly improves the diagnostic accuracy.
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Affiliation(s)
- Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Kyoko Sakai
- Clinical Laboratory, Saiseikai Suita Hospital, Suita, Japan
- Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Takayuki Katayama
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Yasuhide Mitsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Yoshihiro Kanbara
- Hepato-Biliary-Pancreatic Surgery, Saiseikai Suita Hospital, Suita, Japan
| | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan.
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6
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Kato M, Uedo N, Nagahama T, Yao K, Doyama H, Tsuji S, Gotoda T, Kawamura T, Ebi M, Yamamoto K, Akasaka T, Takatori H, Handa O, Akamatsu T, Nishikawa J, Hikichi T, Yamashina T, Imoto A, Kitamura Y, Mikami T, Koike T, Ohara S, Kitamura S, Yamaguchi T, Kinjo T, Inoue T, Suzuki S, Kaneko A, Hirasawa K, Tanaka K, Kotachi T, Miwa K, Toya Y, Kayaba S, Ikehata A, Minami S, Mizukami K, Oya H, Ara N, Fukumoto Y, Komura T, Yoshio T, Morizono R, Yamazaki K, Shimodate Y, Yamanouchi K, Kawata N, Kumagai M, Sato Y, Umeki K, Kawai D, Tanuma T, Kishino M, Konishi J, Sumiyoshi T, Oka S, Kono M, Sakamoto T, Horikawa Y, Ohyauchi M, Hashiguchi K, Waseda Y, Kasai T, Aoyagi H, Oyamada H, Shoji M, Kiyotoki S, Asonuma S, Orikasa S, Akaishi C, Nagami Y, Nakata S, Iida F, Nomura T, Tominaga K, Oka K, Morita Y, Suzuki H, Ozeki K, Kuribayashi S, Akazawa Y, Sasaki S, Mikami T, Miki G, Sano T, Satoh H, Nakamura M, Iwai W, Tawa H, Wada M, Yoshimura D, Hisanaga Y, Shimokawa T, Ishikawa H. Self-study of the non-extension sign in an e-learning program improves diagnostic accuracy of invasion depth of early gastric cancer. Endosc Int Open 2019; 7:E871-E882. [PMID: 31286056 PMCID: PMC6611729 DOI: 10.1055/a-0902-4467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/01/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims We developed an e-learning program for endoscopic diagnosis of invasion depth of early gastric cancer (EGC) using a simple diagnostic criterion called non-extension sign, and the contribution of self-study quizzes to improvement of diagnostic accuracy was evaluated. Methods We conducted a prospective randomized controlled study that recruited endoscopists throughout Japan. After completing a pretest, the participants watched video lectures and undertook post-test 1. The participants were then randomly allocated to either the self-study or non-self-study group, and participants in the first group completed the self-study program that comprised 100-case quizzes. Finally, participants in both groups undertook post-test 2. The primary endpoint was the difference in post-test 2 scores between the groups. The perfect score for the tests was set as 100 points. Results A total of 423 endoscopists completed the pretest and were enrolled. Post-test 1 was completed by 415 endoscopists and 208 were allocated to the self-study group and 207 to the non-self-study group. Two hundred and four in the self-study group and 205 in the non-self-study group were included in the analysis. Video lectures improved the mean score of post-test 1 from 72 to 77 points. Participants who completed the self-study quizzes showed significantly better post-test 2 scores compared with the non-self-study group (80 vs. 76 points, respectively, P < 0.0001). Conclusions Our e-learning program showed that self-study quizzes consolidated knowledge of the non-extension sign and improved diagnostic ability of endoscopists for invasion depth of EGC.
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Affiliation(s)
- Minoru Kato
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Nagahama
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shigetsugu Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Katsumi Yamamoto
- Department of Gastroenterology, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Japan
| | - Tomofumi Akasaka
- Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hajime Takatori
- Department of gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Jun Nishikawa
- Department of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Takeshi Yamashina
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Akira Imoto
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Yoko Kitamura
- Center for Digestive and Liver Disease, Department of Gastroenterology, Nara City Hospital, Nara, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shuichi Ohara
- Department of Gastroenterology, Tohoku Rosai Hospital, Sendai, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tatsuya Yamaguchi
- First Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsu Kinjo
- Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan
| | - Taro Inoue
- Department of Gastroenterology and Hepatology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, Center for Digestive Disease, and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan
| | - Akihiro Kaneko
- Department of Gastroenterological Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kyosuke Tanaka
- Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Takahiro Kotachi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiro Miwa
- Department of Gastroenterology, Komatsu Municipal Hospital, Komatsu, Japan
| | - Yosuke Toya
- Department of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Shoichi Kayaba
- Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Ohshu, Japan
| | - Atsushi Ikehata
- Department of Gastroenterology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Shinya Minami
- Department of Gastroenterology, Oji General Hospital, Tomakomai, Japan
| | | | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Nobuyuki Ara
- Department of Gastroenterology, National Hospital Organization Sendai Medical Hospital, Sendai, Japan
| | - Yasushi Fukumoto
- Department of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takuya Komura
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Ryutaro Morizono
- Section of Gastroenterology, Department of Internal Medicine, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Kenji Yamazaki
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yuichi Shimodate
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Japan
| | - Masayuki Kumagai
- Department of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kiyotaka Umeki
- Department of Gastroenterology, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Daisuke Kawai
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Tokuma Tanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Maiko Kishino
- Department of Gastroenterology, Tokyo Womenʼs Medical University Hospital, Tokyo, Japan
| | - Jun Konishi
- Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan
| | | | - Shohei Oka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuhiro Kono
- Department of Gastroenterology, Higashisumiyoshi Morimoto Hospital, Osaka, Japan
| | - Takeshi Sakamoto
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Yohei Horikawa
- Department of Gastroenterology, Hiraka General Hospital, Yokote, Japan
| | - Motoki Ohyauchi
- Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan
| | | | - Yohei Waseda
- Department of Internal Medicine, Asanogawa General Hospital, Kanazawa, Japan
| | - Toyotaka Kasai
- Department of Gastroenterology, Fukaya Red Cross Hospital, Saitama, Japan
| | - Hiroyuki Aoyagi
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Hirokazu Oyamada
- Department of Gastroenterology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Masakuni Shoji
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Yanai, Japan
| | - Sho Asonuma
- Department of Gastroenterology, South Miyagi Medical Center, Shibata-gun, Japan
| | - Shunsuke Orikasa
- Department of Gastroenterology, Iwate Prefectural Kuji Hospital, Kuji, Japan
| | - Chika Akaishi
- Department of Gastroenterology, Iwate Prefectural Chubu Hospital, Kitakami, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nakata
- Department of Gastroenterology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Fumiyo Iida
- Department of Gastroenterology, Japan Community Healthcare Organization, Kanazawa Hospital, Kanazawa, Japan
| | - Tatsuma Nomura
- Department of Gastroenterology, Kinan Hospital, Minamimuro, Mie, Japan
| | - Kei Tominaga
- Department of Gastroenterology, Kaga Medical Center, Kaga, Japan
| | - Kohei Oka
- Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Yosa, Japan
| | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Keiji Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shiko Kuribayashi
- Clinical Investigation and Research Unit, Gunma University Hospital, Maebashi, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Sho Sasaki
- Department of Gastroenterology, Tokuyama Central Hospital, Shunan, Japan
| | - Tetsuhiko Mikami
- Department of Gastroenterology, Towada City Hospital, Towada, Japan
| | - Goro Miki
- Department of Gastroenterology, Nobeoka Medical Association Hospital, Nobeoka, Japan
| | - Tatsushi Sano
- Department of Gastroenterology, Moriguchi Keijinkai Hospital, Moriguchi, Japan
| | - Hiro Satoh
- Department of Gastroenterology, Midori Municipal Hospital, Nagoya, Japan
| | | | - Wataru Iwai
- Department of Gastroenterology, Miyagi Cancer Center, Natori, Japan
| | - Hideki Tawa
- Department of Gastroenterology, Seikeikai Hospital, Sakai, Japan
| | - Masafumi Wada
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Daisuke Yoshimura
- Division of Gastroenterology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yasuhiro Hisanaga
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Toshio Shimokawa
- Department of Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
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7
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Takahashi A, Shima T, Kinoshita N, Yano K, Ueno T, Nishiwaki M, Yamamoto Y, Oya H, Amano I, Matsumoto J, Mitsumoto Y, Tanaka I, Sakai K, Sawai N, Mizuno C, Mizuno M, Itoh Y, Okanoue T. [The impact of direct-acting antiviral therapy on the diagnosis of hepatitis-C virus-associated hepatocellular carcinoma]. Nihon Shokakibyo Gakkai Zasshi 2019; 115:184-194. [PMID: 29459562 DOI: 10.11405/nisshoshi.115.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since the introduction of direct-acting antiviral (DAA)-based combination therapies in September 2014 for patients with chronic hepatitis-C (CH-C), numerous patients have been diagnosed with hepatitis-C virus (HCV)-associated hepatocellular carcinomas (HCCs) during the screening performed prior to DAA therapy. The present study was conducted on the antiviral therapy for CH-C in two phases:i) the interferon (IFN) phase between January 2011 and August 2014 and ii) the DAA phase between September 2014 and September 2016. During the DAA phase, HCCs were detected in eight patients who were referred to our hospital for anti-HCV therapy. In contrast, HCCs were detected in only two patients during the IFN phase. The number of patients with newly detected HCC in the DAA phase (20.5%) who were referred for the anti-HCV therapy was significantly higher than that in the IFN phase (1.7%). Owing to the high efficacy and safety of the DAA therapy, the number of patients referred to our hospital for anti-HCV therapy increased from 40.5 persons/year in the IFN phase to 80.3 persons/year in the DAA phase. The average ages of patients in the DAA and IFN phases were 68 and 61 years, respectively. The increase in the number of patients with newly detected HCC referred for the anti-HCV therapy in the DAA phase could be attributed to the increase in the number of referred patients for anti-HCV therapy and the aging of these patients in the DAA phase. All the eight patients with newly detected HCC who were referred for anti-HCV therapy in the DAA phase received curative treatments. The median age, rate of liver cirrhosis, and median tumor size of the patients were 69 years, 13%, and 16mm. Therefore, the findings of this study indicate that DAA therapies not only eradicate HCV infection but also contribute to the early diagnosis of HCC by encouraging the HCV-infected patients to visit hospitals and by promoting active network between hepatologists and family physicians.
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Affiliation(s)
- Aya Takahashi
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | - Toshihide Shima
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | | | - Kota Yano
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | - Tomoko Ueno
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | | | | | - Hirohisa Oya
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | - Ichiro Amano
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | - Junko Matsumoto
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | | | - Izumi Tanaka
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | - Kyoko Sakai
- Department of Clinical Laboratory, Osaka Saiseikai Suita Hospital
| | - Naoki Sawai
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | - Chiemi Mizuno
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | - Masayuki Mizuno
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
| | - Yoshito Itoh
- Department of Gastroenterology, Kyoto Prefectural University of Medicine
| | - Takeshi Okanoue
- Department of Gastroenterology, Osaka Saiseikai Suita Hospital
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8
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Boes A, Trapp N, Uitermarkt B, Gander P, Bruss J, Howard M, Oya H. Effects of transcranial magnetic stimulation on the human brain revealed by intracranial electrocorticography. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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9
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Nishiwaki M, Mizuno C, Yano K, Oya H, Amano I, Matsumoto J, Tanaka I, Sawai N, Mizuno M, Shima T, Miyamoto Y, Okanoue T. Retroperitoneal Perforation Caused by Migration of a Pancreatic Spontaneous Dislodgement Stent into Periampullary Diverticula. Intern Med 2018; 57:351-355. [PMID: 29093393 PMCID: PMC5827315 DOI: 10.2169/internalmedicine.9054-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
An 85-year-old woman underwent endoscopic retrograde cholangiopancreatography (ERCP) for obstructive jaundice. Selective bile duct cannulation was unsuccessful because of periampullary diverticula (PAD). A pancreatic spontaneous dislodgement stent (PSDS) (5F diameter, 3 cm, straight type) was inserted to prevent post-ERCP pancreatitis. Three days after ERCP, she complained of abdominal pain, and computed tomography revealed retroperitoneal perforation because of PSDS migration to the PAD. If the papillary orifice is observed at the diverticular rim or in the diverticula, a pigtailed PSDS on the duodenal side or flanged stent on the pancreatic ductal side should be inserted in order to prevent this rare adverse event.
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Affiliation(s)
- Masatake Nishiwaki
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Chiemi Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Kota Yano
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Ichiro Amano
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Junko Matsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Izumi Tanaka
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Naoki Sawai
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | | | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
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10
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Seki K, Shima T, Oya H, Mitsumoto Y, Mizuno M, Okanoue T. Assessment of transient elastography in Japanese patients with non-alcoholic fatty liver disease. Hepatol Res 2017; 47:882-889. [PMID: 27753194 DOI: 10.1111/hepr.12829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/28/2016] [Accepted: 10/16/2016] [Indexed: 12/15/2022]
Abstract
AIM Transient elastography (TE) is a non-invasive method for predicting liver fibrosis. However, there are limited data regarding the performance of TE in Japanese patients with non-alcoholic fatty liver disease (NAFLD). We aimed to evaluate the association between liver stiffness measurement (LSM) by TE and liver fibrosis stage, and define a cut-off value for predicting liver fibrosis. METHODS A total of 171 Japanese patients with biopsy-proven NAFLD underwent LSM using TE with FibroScan. The area under the receiver operating characteristic curve of LSM and other non-invasive markers of liver fibrosis were compared to determine the most accurate method of predicting liver fibrosis. RESULTS Liver stiffness measurement significantly correlated with fibrosis stage (P < 0.001). The areas under the receiver operating characteristic curve of LSM for fibrosis stage ≥1 and ≥3 was 0.85 and 0.91, respectively and were higher than those of the aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index, fibrosis-4 index, and NAFLD fibrosis score. The best cut-off values of LSM fibrosis stage ≥1 and ≥3 were 7.2 kPa (sensitivity 78.5%, specificity 78.3%) and 10.0 kPa (sensitivity 89.5%, specificity 87.6%), respectively. The combination of LSM (≥10 kPa) and type IV collagen 7 s (≥6.0 ng/mL) had a specificity of 97.6% for advanced fibrosis. The LSM in patients with high alanine aminotransferase levels or high body mass index was associated with false positive results regarding advanced fibrosis. CONCLUSIONS In NAFLD patients, TE has excellent utility for the assessment of liver fibrosis, particularly for advanced stage cases. The cut-off value of LSM by TE for predicting liver fibrosis stage ≥3 is 10.0 kPa in Japanese NAFLD patients.
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Affiliation(s)
- Kojiro Seki
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Yasuhide Mitsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
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11
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Mizuno M, Shima T, Oya H, Mitsumoto Y, Mizuno C, Isoda S, Kuramoto M, Taniguchi M, Noda M, Sakai K, Koyama N, Okanoue T. Classification of patients with non-alcoholic fatty liver disease using rapid immunoassay of serum type IV collagen compared with liver histology and other fibrosis markers. Hepatol Res 2017; 47:216-225. [PMID: 26997642 DOI: 10.1111/hepr.12710] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 12/12/2022]
Abstract
AIM Non-alcoholic fatty liver disease (NAFLD) can progress to non-alcoholic fatty liver (NAFL) or non-alcoholic steatohepatitis (NASH). We investigated the association among serum type IV collagen level, liver histology, and other fibrosis markers in NAFLD progression. METHODS We evaluated 184 patients diagnosed with NAFLD following biopsy, including 89 males and 95 females with an average age of 52.6 and 62.6 years, respectively. Non-alcoholic fatty liver disease was classified as NAFL or NASH using Matteoni's classification, and the grade and stage of NASH were assessed using Brunt's classification. Serum type IV collagen was measured by a rapid and sensitive latex particle-enhanced turbidimetric immunoassay. RESULTS Forty-two patients with NAFL and 142 patients with NASH were included in this study. Compared with patients with NAFL, patients with NASH showed more significant liver function disorder and increased expression of fibrosis markers including type IV collagen, collagen 7S, Mac2-binding protein (M2BP), and hyaluronic acid (HA). Expression of type IV collagen and collagen 7S, but not M2BP and HA, was more significantly elevated in patients with stage 1 NASH than in patients with NAFL, indicating that type IV collagen and collagen 7S may be better discriminators of NASH and NAFL than M2BP and HA at an early stage of fibrosis. When patients were stratified by NAFLD activity score, type IV collagen and collagen 7S were significantly elevated as NAFLD activity score progressed, whereas M2BP and HA expression were not significantly elevated. CONCLUSION Type IV collagen may be a useful measure of NASH severity as latex particle-enhanced turbidimetric immunoassay-based rapid type IV collagen assay can be carried out routinely.
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Affiliation(s)
- Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan
| | - Yasuhide Mitsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan
| | - Chiemi Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan
| | - Satoshi Isoda
- Department of Clinical Laboratory, Saiseikai Suita Hospital, Osaka, Japan
| | - Mizue Kuramoto
- Department of Clinical Laboratory, Saiseikai Suita Hospital, Osaka, Japan
| | - Masanori Taniguchi
- Department of Clinical Laboratory, Saiseikai Suita Hospital, Osaka, Japan
| | - Masashi Noda
- Department of Clinical Laboratory, Saiseikai Suita Hospital, Osaka, Japan
| | - Kyoko Sakai
- Department of Clinical Laboratory, Saiseikai Suita Hospital, Osaka, Japan
| | | | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan
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12
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Oya H, Kanda M, Koike M, Iwata N, Niwa Y, Shimizu D, Takami H, Sueoka S, Hashimoto R, Ezaka K, Nomoto S, Yamada S, Fujii T, Nakayama G, Sugimoto H, Fujiwara M, Kodera Y. Detection of serum melanoma-associated antigen D4 in patients with squamous cell carcinoma of the esophagus. Dis Esophagus 2016; 29:663-9. [PMID: 25951896 DOI: 10.1111/dote.12373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite improvements in surgical techniques, perioperative management, and multidisciplinary therapy, treatment outcomes of patients with esophageal squamous cell carcinoma (ESCC) remain poor. Therefore, development of novel molecular biomarkers, which either predict patient survival or become therapeutic targets, is urgently required. In the present study, to facilitate early detection of ESCC and predict its clinical course, we investigated the relationship of the serum level of melanoma-associated antigen (MAGE)-D4 to patients' clinicopathological characteristics. Using quantitative real-time reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assays, we determined the levels of MAGE-D4 mRNA and protein in cell lysates and conditioned medium of cultures, respectively, of nine ESCC cell lines. Further, we determined MAGE-D4 levels in serum samples collected from 44 patients with ESCC who underwent radical esophagectomy without neoadjuvant therapy as well as from 40 healthy volunteers. Samples of conditioned medium and cell lysates contained comparable levels of MAGE-D4 that correlated closely with the levels of MAGE-D4 mRNA. Preoperative MAGE-D4 levels in the sera of 44 patients with ESCC, which varied from 0 to 2,354 pg/mL (314 ± 505 pg/mL, mean ± standard deviation), were significantly higher compared with those of healthy volunteers. By setting the cutoff at the highest value for healthy volunteers (50 pg/mL), the MAGE-D4-positive group of patients was more likely to have shorter disease-specific and disease-free survival compared with those of the MAGE-D4-negative group, although the differences were not statistically significant. Our results indicate that the elevation of preoperative serum MAGE-D4 levels in some patients with ESCC was possibly caused by excess production of MAGE-D4 by tumor cells followed by its release into the circulation. Clinical implications of serum MAGE-D4 levels should be validated in a large population of patients with ESCC.
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Affiliation(s)
- H Oya
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Koike
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Iwata
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Niwa
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - D Shimizu
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Takami
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Sueoka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - R Hashimoto
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Ezaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Nomoto
- Department of Surgery, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
| | - S Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Fujii
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - G Nakayama
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Sugimoto
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Fujiwara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Niwa Y, Koike M, Fujimoto Y, Oya H, Iwata N, Nishio N, Hiramatsu M, Kanda M, Kobayashi D, Tanaka C, Yamada S, Fujii T, Nakayama G, Sugimoto H, Nomoto S, Fujiwara M, Kodera Y. Salvage pharyngolaryngectomy with total esophagectomy following definitive chemoradiotherapy. Dis Esophagus 2016; 29:598-602. [PMID: 26338205 DOI: 10.1111/dote.12362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Historically, total pharyngolaryngectomy with total esophagectomy has been the standard radical surgical treatment for synchronous cancer of the thoracoabdominal esophagus and pharyngolaryngeal region, and for cancer of the cervical esophagus that has invaded as far as the thoracic esophagus. Although definitive chemoradiotherapy that enables preservation of the larynx has often been the first choice of treatment for cancers involving the cervical esophagus, total pharyngolaryngectomy with total esophagectomy is required as a salvage therapy for cases involving failure of complete remission or locoregional recurrence after chemoradiotherapy. However, salvage esophageal surgery after definitive high-dose chemoradiotherapy is generally associated with high morbidity and mortality. The aim of this study was to examine the short-term outcome of salvage total pharyngolaryngectomy with total esophagectomy. From 2001 to 2014, nine patients underwent salvage total pharyngolaryngectomy with total esophagectomy at the Department of Gastroenterological Surgery, Nagoya University. The mortality and morbidity rates were high at 22% and 89%, respectively. Four patients (44%) developed tracheal necrosis, which in two patients eventually led to lethal hemorrhage. Salvage total pharyngolaryngectomy with total esophagectomy is an uncommon and highly demanding surgical procedure that should be carefully planned and conducted in selected centers of excellence. Measures must be taken to preserve the tracheal blood supply, thus avoiding fatal complications.
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Affiliation(s)
- Y Niwa
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Koike
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Oya
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Iwata
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - D Kobayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - C Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Fujii
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - G Nakayama
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Sugimoto
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Nomoto
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Fujiwara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
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14
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Kingyon J, Behroozmand R, Kelley R, Oya H, Kawasaki H, Narayanan NS, Greenlee JDW. High-gamma band fronto-temporal coherence as a measure of functional connectivity in speech motor control. Neuroscience 2015; 305:15-25. [PMID: 26232713 DOI: 10.1016/j.neuroscience.2015.07.069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/13/2015] [Accepted: 07/25/2015] [Indexed: 11/19/2022]
Abstract
The neural basis of human speech is unclear. Intracranial electrophysiological recordings have revealed that high-gamma band oscillations (70-150Hz) are observed in the frontal lobe during speech production and in the temporal lobe during speech perception. Here, we tested the hypothesis that the frontal and temporal brain regions had high-gamma coherence during speech. We recorded electrocorticography (ECoG) from the frontal and temporal cortices of five humans who underwent surgery for medically intractable epilepsy, and studied coherence between the frontal and temporal cortex during vocalization and playback of vocalization. We report two novel results. First, we observed high-gamma band as well as theta (4-8Hz) coherence between frontal and temporal lobes. Second, both high-gamma and theta coherence were stronger when subjects were actively vocalizing as compared to playback of the same vocalizations. These findings provide evidence that coupling between sensory-motor networks measured by high-gamma coherence plays a key role in feedback-based monitoring and control of vocal output for human vocalization.
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Affiliation(s)
- J Kingyon
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - R Behroozmand
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States; Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States
| | - R Kelley
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - H Oya
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - H Kawasaki
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - N S Narayanan
- Department of Neurology, University of Iowa, Iowa City, IA, United States; Aging Mind and Brain Initiative, Carver College of Medicine, University of Iowa, Iowa City, IA, United States.
| | - J D W Greenlee
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States.
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15
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Shima T, Seki K, Umemura A, Ogawa R, Horimoto R, Oya H, Sendo R, Mizuno M, Okanoue T. Influence of lifestyle-related diseases and age on the development and progression of non-alcoholic fatty liver disease. Hepatol Res 2015; 45:548-59. [PMID: 24976563 DOI: 10.1111/hepr.12384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/15/2014] [Accepted: 06/23/2014] [Indexed: 02/08/2023]
Abstract
AIM Although non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome, the clinical association between non-alcoholic steatohepatitis (NASH) and lifestyle-related diseases such as obesity, type 2 diabetes mellitus (DM), hypertension (HT) and dyslipidemia (DL) has not been clarified. We studied the influence of lifestyle-related diseases and age on the development and progression of NAFLD. METHODS We enrolled 550 patients with biopsy-proven NAFLD (284 men, 266 women; average age, 52 and 62 years, respectively). The effect of lifestyle-related diseases and age (≤49 vs ≥50 years) on the frequency of NASH and advanced fibrosis (≥stage 3) was studied. RESULTS Prevalence of obesity, DM, HT and DL in male and female NASH patients was 75%/67%, 53%/54%, 66%/77% and 85/79%, respectively. DM patients had a higher frequency of NASH in the older male NAFLD group and a higher frequency of advanced fibrosis in the older female NASH group. With the increasing number of complicating lifestyle-related diseases, the rate of NASH increased in male NAFLD patients. In both sexes, aging resulted in the development of NASH and progression of liver fibrosis. Multivariate logistic regression analysis revealed that age and DM were significantly associated with the development of NASH in male NAFLD patients and progression of fibrosis in female NASH patients. CONCLUSION Age is strongly associated with the development and progression of NASH. Type 2 DM may play the most crucial role among lifestyle-related diseases in the development and progression of NASH.
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Affiliation(s)
- Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan
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Kanda M, Shimizu D, Sugimoto H, Oya H, Hibino S, Takami H, Hashimoto R, Okamura Y, Yamada S, Fujii T, Nakayama G, Koike M, Nomoto S, Fujiwara M, Kodera Y. B-Cell Translocation Gene 1 Serves As a Novel Prognostic Indicator of Hepatocellular Carcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Shimizu D, Kanda M, Sugimoto H, Oya H, Takami H, Hibino S, Hashimoto R, Okamura Y, Yamada S, Fujii T, Nakayama G, Koike M, Nomoto S, Fujiwara M, Kodera Y. Identification of Intragenic Methylation in the Tusc1 Gene As a Novel Prognostic Marker of Hepatocellular Carcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Kobayashi T, Miura K, Ishikawa H, Oya H, Sato Y, Minagawa M, Sakata J, Takano K, Takizawa K, Nogami H, Kosugi SI, Wakai T. Laparoscope-assisted Hassab's operation for esophagogastric varices after living donor liver transplantation: a case report. Transplant Proc 2014; 46:986-8. [PMID: 24767398 DOI: 10.1016/j.transproceed.2013.10.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
Abstract
This is the first successful report of a laparoscope-assisted Hassab's operation for esophagogastric varices after living donor liver transplantation (LDLT). A 35-year-old man underwent LDLT using a right lobe graft as an aid for primary sclerosing cholangitis (PSC) in 2005. Follow-up endoscopic and computed tomography (CT) examinations showed esophagogastric varices with splenomegaly in 2009 that increased (esophageal varices [EV]: locus superior [Ls], moderator enlarged, beady varices [F2], medium in number and intermediate between localized and circumferential red color signs [RC2]; gastric varices [GV]: extension from the cardiac orifice to the fornix [Lg-cf], moderator enlarged, beady varices [F2], absent red color signs [RC0]). A portal venous flow to the esophagogastric varices through a large left gastric vein was also confirmed. Preoperative Child-Pugh was grade B and score was 9. Because these esophagogastric varices had a high risk of variceal bleeding, we proceeded with a laparoscope-assisted Hassab's operation. Operative time was 464 minutes. Blood loss was 1660 mL. A graft liver biopsy was also performed and recurrence of PSC was confirmed histologically. It was suggested that portal hypertension and esophagogastric varices were caused by recurrence of PSC. Postoperative complications were massive ascites and enteritis. Both of them were treated successfully. This patient was discharged on postoperative day 43. Follow-up endoscopic study showed improvement in the esophagogastric varices (esophageal varices [EV]: locus superior [Ls], no varicose appearance [F0], absent red color signs [RC0], gastric varices [GV]: adjacent to the cardiac orifice [Lg-c], no varicose appearance [F0], absent red color signs [RC0]) at 6 months after the operation. We also confirmed the improvement of esophagogastric varices by serial examinations of CT.
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Affiliation(s)
- T Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - K Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - H Ishikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - H Oya
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Y Sato
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - M Minagawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - J Sakata
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Takano
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Takizawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - H Nogami
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - S-I Kosugi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - T Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Viljoen S, Oya H, Reddy CG, Dalm BD, Shurig R, Odden K, Gillies GT, Howard MA. Apparatus for simulating dynamic interactions between the spinal cord and soft-coupled intradural implants. Rev Sci Instrum 2013; 84:114303. [PMID: 24289414 DOI: 10.1063/1.4831801] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We have designed, built, and tested an apparatus used for investigating the biomechanical response of a novel intradural spinal cord stimulator to the simulated physiological movement of the spinal cord within the thecal sac. In this apparatus, the rostral-caudal displacements of an anthropomorphic spinal cord surrogate can be controlled with a resolution of approximately 0.1% of a target value for up to 10(7) lateral movement cycles occurring at a repetition rate of 2 Hz. Using this system, we have been able to determine that the restoring force of the stimulator's suspension system works in concert with the frictional coupling between the electrode array and the surrogate to overcome the 0.42 μN inertial force associated with the lateral motion of the array. The result is a positional stability of the array on the surrogate (in air) of better than 0.2 mm over ~500,000 movement cycles. Design modifications that might lead to improved physiological performance are discussed.
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Affiliation(s)
- S Viljoen
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242, USA
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20
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Oya H, Kanda M, Takami H, Hibino S, Shimizu D, Niwa Y, Koike M, Nomoto S, Yamada S, Nishikawa Y, Asai M, Fujii T, Nakayama G, Sugimoto H, Fujiwara M, Kodera Y. Overexpression of melanoma-associated antigen D4 is an independent prognostic factor in squamous cell carcinoma of the esophagus. Dis Esophagus 2013; 28:188-95. [PMID: 24147998 DOI: 10.1111/dote.12156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To pursue an urgently needed treatment target for esophageal cancer (EC), we investigated the function of the recently discovered melanoma-associated antigen (MAGE)-D4 in squamous cell EC. MAGE-D4 messenger RNA (mRNA) expression was analyzed in nine EC cell lines using quantitative reverse transcription polymerase chain reaction. In 65 surgical specimens of squamous cell EC with no prior neoadjuvant therapy, MAGE-D4 mRNA expression in EC tissues and corresponding normal tissues was analyzed and compared, and evaluated in terms of clinicopathological factors. In representative cases, MAGE-D4 protein distribution was analyzed immunohistochemically. The heterogeneity of MAGE-D4 mRNA expression was confirmed in EC cell lines by quantitative reverse transcription polymerase chain reaction. In surgical specimens, MAGE-D4 mRNA expression was significantly higher in EC tissues than in corresponding normal tissues (P < 0.001). Patients with the highest MAGE-D4 mRNA expression in EC tissues (top quartile, n = 17) had significantly shorter overall survival than patients with low expression (2-year survival: 44% and 73%, respectively, P = 0.006). Univariate analysis identified age (≥65 years), lymphatic involvement, and high MAGE-D4 mRNA expression as significant prognostic factors; high MAGE-D4 mRNA expression was also an independent prognostic factor in multivariable analysis (hazard ratio: 2.194; P = 0.039) and was significantly associated with Brinkman index (P = 0.008) and preoperative carcinoembryonic antigen level (P = 0.002). Immunohistochemical MAGE-D4b expression was consistent with MAGE-D4 mRNA profiling. Our results suggest that MAGE-D4 overexpression influences tumor progression, and MADE-D4 can be a prognostic marker and a potential molecular target in squamous cell EC.
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Affiliation(s)
- H Oya
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
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21
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Amano I, Sawai N, Mizuno C, Shaura Y, Nishiwaki M, Horimoto R, Oya H, Kato R, Seki K, Hashimoto H, Amakata Y, Matsumoto J, Tanaka I, Mizuno M, Shima T, Okanoue T. [A case of HER2-positive and AFP-producing gastric cancer successfully treated by trastuzumab/docetaxel/S-1 combination therapy]. Gan To Kagaku Ryoho 2012; 39:2541-2544. [PMID: 23235175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 74-year-old man was referred to our hospital because of abdominal distension. Upper gastrointestinal endoscopy revealed advanced gastric cancer and early gastric cancer. HER2-positive and AFP-producing gastric cancer with peritonitis carcinomatosa showing no indication for operation was diagnosed by histopathological and radiological examinations. He was treated with trastuzumab, docetaxel, and S-1 combination chemotherapy. At the end of the second course of therapy, the primary lesion was remarkably decreased in size and was associated with a significant decrease in serum AFP level. No serious adverse events occurred except for grade 3-4 leukopenia and neutropenia. We carried out eight courses of chemotherapy. Trastuzumab, docetaxel, and S-1 combination chemotherapy promise to be one of the effective treatments for HER2-positive and AFP-producing gastric cancer that have no indication for radical cure excision.
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Affiliation(s)
- Ichiro Amano
- Dept. of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
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22
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23
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Garell PC, Bakken H, Greenlee JDW, Volkov I, Reale RA, Oya H, Kawasaki H, Howard MA, Brugge JF. Functional connection between posterior superior temporal gyrus and ventrolateral prefrontal cortex in human. Cereb Cortex 2012; 23:2309-21. [PMID: 22879355 DOI: 10.1093/cercor/bhs220] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The connection between auditory fields of the temporal lobe and prefrontal cortex has been well characterized in nonhuman primates. Little is known of temporofrontal connectivity in humans, however, due largely to the fact that invasive experimental approaches used so successfully to trace anatomical pathways in laboratory animals cannot be used in humans. Instead, we used a functional tract-tracing method in 12 neurosurgical patients with multicontact electrode arrays chronically implanted over the left (n = 7) or right (n = 5) perisylvian temporal auditory cortex (area PLST) and the ventrolateral prefrontal cortex (VLPFC) of the inferior frontal gyrus (IFG) for diagnosis and treatment of medically intractable epilepsy. Area PLST was identified by the distribution of average auditory-evoked potentials obtained in response to simple and complex sounds. The same sounds evoked little if there is any activity in VLPFC. A single bipolar electrical pulse (0.2 ms, charge-balanced) applied between contacts within physiologically identified PLST resulted in polyphasic evoked potentials clustered in VLPFC, with greatest activation being in pars triangularis of the IFG. The average peak latency of the earliest negative deflection of the evoked potential on VLPFC was 13.48 ms (range: 9.0-18.5 ms), providing evidence for a rapidly conducting pathway between area PLST and VLPFC.
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Affiliation(s)
- P C Garell
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
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24
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Sakamoto T, Sato Y, Yamamoto S, Oya H, Hatakeyama K. De novo ulcerative colitis and autoimmune hepatitis after living related liver transplantation from cytomegalovirus-positive donor to cytomegalovirus-negative recipient: a case report. Transplant Proc 2012; 44:570-3. [PMID: 22410071 DOI: 10.1016/j.transproceed.2012.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND De novo autoimmune hepatitis (AIH) after liver transplantation (OLT) has been reported; however, de novo ulcerative colitis (UC) combined with AIH after OLT is rare. MATERIALS AND METHODS We report a patient who suffered de novo UC with AIH after living related OLT (LRLT) due to fulminant hepatitis using a cytomegalovirus (CMV)-positive donor to a CMV-negative recipient. RESULTS A 32-year-old man underwent LRLT due to fuluminant hepatis 4 years prior. He was admitted for colitis with diarrhea, abdominal pain, and high fever in March 2010. The abdominal computed tomography revealed severe jejunal edema. Anti-infectious therapies for bacterial, fungal, and CMV cases were ineffective. Small bowel endoscopy demonstrated erosion, redness, ulceration, and edema from the stomach to the jejunum. However, the origin of the colitis was not clear. Thereafter he displayed melena with a high fever and abdominal pain. The colon revealed diffuse inflammation with pseudopolyposis. De novo UC or CMV infection was suspected. His symptoms improved upon administration of salazopyrin and denosine. Moreover, he suffered de novo AIH, which was diagnosed by liver biopsy 3 months after the de novo UC. Steroid therapy improved the AIH. CONCLUSIONS It has been reported that CMV is involved with UC and rejection. Our case suggested that CMV might induce de novo UC or AIH in CMV-negative recipients.
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Affiliation(s)
- T Sakamoto
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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25
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Sato Y, Chikako T, Oya H, Yamamoto S, Kokai H, Miura K, Hatakeyama K. Regulatory T-cell activation among patients who displayed operational tolerance following intra-portal administration of donor-specific antigens in living donor liver transplantation. Transplant Proc 2012; 44:560-4. [PMID: 22410069 DOI: 10.1016/j.transproceed.2012.01.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Immunologic tolerance is the goal for all transplant surgeons. We have reported that repeated donor-specific antigen transfusion (DST) via the portal vein allowed rapid reduction of immunosuppressants with decreased acute cellular rejection episodes among living donor liver transplantations (LDLT). Moreover, we demonstrated that intraportal DST induced macrochimerism of donor type CD56+ T cells in the liver graft. We examined the impact of FoxP3+CD4+CD25+ T cells in recipients who acquired almost tolerance after LDLT with intraportal DST. We defined the amount of immunosuppressants administered less than one time per week as "almost tolerance" after LDLT, which occurred among 14% of DST patients after adult-to-adult LDLT. Two patients (4%) have gotten been we used from immunosuppressants more than 2 years after LDLT 4 years prior. We examined the impact of FoxP3+CD4+CD25+ T cells both in recipients with almost daily immunosuppressants and those who acquired almost tolerance. The proportion of FoxP3+/CD4+CD25+ T cells in the almost tolerance group was significantly higher than that in the almost daily immunosuppressant group (P<.05). The increased proportion of FoxP3+/CD4+CD25+ T cells significantly correlated with time after LRLT (y=0.0964x+42.02, R2=0.8854). Repeated intraportal DST may be a goot tool to induce immunologic tolerance after LDLT. Both donor type CD56+ T cells and FoxP3+/CD4+CD25+ T cells may act as important regulatory cells for tolerance. The period after LDLT is important for acquiring immunologic tolerance.
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Affiliation(s)
- Y Sato
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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26
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Kobayashi T, Sato Y, Yamamoto S, Oya H, Kokai H, Hatakeyama K. The inferior mesenteric vein to the left gonadal vein shunt for gastroesophageal varices and extrahepatic portal vein thrombosis after living donor liver transplantation: a case report. Transplant Proc 2012; 44:591-3. [PMID: 22410077 DOI: 10.1016/j.transproceed.2012.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This 59-year-old woman underwent living donor liver transplantation using a left lobe graft as an aid for autoimmune hepatitis in 2003. Splenectomy was also performed because of blood type incompatibility. Follow-up endoscopic and computed tomography examinations showed gastroesophageal varices with extra hepatic portal vein thrombosis in 2007 that increased (esophageal varices [EV]: locus superior [Ls], moderately enlarged, beady varices [F2], Blue varices [Cb], presence of small in number and localized red color sign [RC1] and telangiectasia [TE+], gastric varices [GV]: extension from the cardiac orifice to the fornix [Lg-cf], moderately enlarged, beady varices [F2], white varices [Cw], absence of red color sign [RC-]). Portal venous flow to the gastroesophageal varices was also confirmed from a large right gastric vein. The splenic vein was thrombosed. Blood flow to the liver graft was totally supplied from the hepatic artery. The graft was functioning well. Because these gastroesophageal varices had a high risk of variceal bleeding, we decided to proceed with a portal reconstruction of a surgical portosystemic shunt in 2008. Severe adhesions were observed around the portal vein. It was impossible to perform portal reconstruction. There were relatively fewes adhesious in the left lower side of the abdominal cavity. We decided to create an inferior mesenteric vein to left gonadal vein shunt. The portal vein pressure decreased from 31.0 to 21.5 cm H2O thereafter. The postoperative course was smooth without any complication. This patient was discharged on the postoperative day 15. Follow-up endoscopic study showed the improvement in the gastroesophageal varices (EV: Ls, F2, Cb, RC(-), GV: Lg-c, F2, Cw, RC-) at 3 months after the operation. We also comfirmed the patency of the shunt by serial computed tomography examinations.
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Affiliation(s)
- T Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, and Department of Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan.
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27
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Oya H, Sato Y, Yamanouchi E, Yamamoto S, Hara Y, Kokai H, Sakamoto T, Miura K, Shioji K, Aoyagi Y, Hatakeyama K. Magnetic compression anastomosis for bile duct stenosis after donor left hepatectomy: a case report. Transplant Proc 2012; 44:806-9. [PMID: 22483501 DOI: 10.1016/j.transproceed.2012.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Magnetic compression anastomosis (MCA) provides a minimally invasive treatment creating a nonsurgical, sutureless enteric anastomosis in conjunction with an interventional radiologic technique by using 2 high-power magnets. Recently, the MCA technique has been applied to bile duct strictures after living donor liver transplantation or major hepatectomy. Herein we described use of MCA for bile duct stenosis 5 months after donor left hepatectomy in a 24-year-old man who presented with a stricture at the porta hepatis and intrahepatic bile duct dilatation. Unsuccessful transpapillary biliary drainage and balloon dilatation through a percutaneous transhepatic biliary drainage (PTBD) route led to the MCA. A 4-mm-diameter cylindrical samarium-cobalt (Sm-Co) daughter magnet with a long nylon wire was placed at the superior site of the obstruction through the PTBD route. A 5-mm-diameter Sm-Co parent magnet with an attached nylon handle was endoscopically inserted into the common bile duct and placed at the inferior site of obstruction. The 2 magnets were attracted, sandwiching the stricture and establishing a reanastomosis. In conclusion, the MCA technique was a unique procedure for choledochocholedochostomy in a patient with bile duct stenosis after donor hepatectomy.
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Affiliation(s)
- H Oya
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Miura K, Sato Y, Kokai H, Hara Y, Kobayashi T, Oya H, Yamamoto S, Hatakeyama K. Liver Transplantation Surgical Techniques for Extensive Retroperitoneal Tumor With Major Blood Vessel Involvement: A Case Report. Transplant Proc 2012; 44:579-80. [DOI: 10.1016/j.transproceed.2012.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Oya H, Reddy CG, Dahdaleh NS, Wilson S, Howard MA, Jeffery ND, Utz M, Gillies GT. Applier tool for intradural spinal cord implants. J Med Eng Technol 2012; 36:169-73. [DOI: 10.3109/03091902.2011.649884] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Yamaguchi H, Kataoka M, Oya H, Tominaga A, Ohtsu M, Okajima T, Tanizawa K. Time-resolved analysis of catalytic reaction of copper amine oxidase from Arthrobacter globiformis. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311094384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Miura K, Sato Y, Yamamoto S, Oya H, Hara Y, Kobayashi T, Hatakeyama K. EFFICACY OF HETEROTOPIC AUXILIARY PARTIAL LIVER TRANSPLANTATION IN LIVING DONOR TRANSPLANTATION. Transplantation 2010. [DOI: 10.1097/00007890-201007272-01533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Kobayashi T, Sato Y, Yamamoto S, Takeishi T, Oya H, Hideki N, Kokai H, Kurosaki I, Hatakeyama K. Auxiliary Partial Orthotopic Living Donor Liver Transplantation for Fulminant Hepatic Failure With Flat Electroencephalogram: A Case Report. Transplant Proc 2010; 42:990-3. [DOI: 10.1016/j.transproceed.2010.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Kokai H, Sato Y, Yamamoto S, Oya H, Nakatsuka H, Kobayashi T, Watanabe T, Takizawa K, Hatakeyama K. The new method of time-lag ligation for portosystemic shunt using coronary artery bypass graft occluder for adult living donor liver transplantation. Transplant Proc 2009; 41:4259-61. [PMID: 20005380 DOI: 10.1016/j.transproceed.2009.08.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 08/03/2009] [Accepted: 08/17/2009] [Indexed: 11/19/2022]
Abstract
We performed a living donor liver transplantation (LDLT) for a 57-year-old man who had end-stage liver failure with portal hypertension and an inferior mesenteric vein-left testicular vein (IMV-LTV) shunt. At operation, we did not clamp the shunt but encircled it with a coronary artery bypass graft (CABG) occluder (Sumitomo Bakelite K.K., Japan), which was passed outside the body through the abdominal wall to time-lag ligation (TLL). On postoperative day (POD) 5, we observed decreased portal flow. We performed TLL of the shunt using the CABG occluder without re-laparotomy. The portal flow increased, while the portal vein pressure increased slightly. In LDLT, portosystemic shunt has been reported to be a cause of portal thrombus formation or graft liver atrophy due to decreased PV flow in the mid postoperative period. However, perioperative ligation of a portosystemic shunt may prevent regeneration of the grafted liver because of excessive portal hypertension. Therefore the technique of time-lag ligation of a portosystemic shunt using a CABG occluder may be a minimally invasive, useful method to achieve physiological liver graft regeneration.
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Affiliation(s)
- H Kokai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, I-754 Asahimachi-Dori, Niigata 951-8510, Japan.
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Kobayashi T, Sato Y, Yamamoto S, Oya H, Hara Y, Watanabe T, Kokai H, Hatakeyama K. Feasibility of auxiliary partial living donor liver transplantation for fulminant hepatic failure as an aid for small-for-size graft: single center experience. Transplant Proc 2009; 41:262-4. [PMID: 19249530 DOI: 10.1016/j.transproceed.2008.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 10/20/2008] [Accepted: 10/29/2008] [Indexed: 02/07/2023]
Abstract
Auxiliary partial orthotopic liver transplantation (APOLT) or heterotopic auxiliary partial liver transplantation (HAPLT) was initially indicated for potentially reversible fulminant hepatic failure (FHF). We started auxiliary partial living donor liver transplantation (LDLT) for FHF in February 2002. Since then, 5 FHF patients (3 females and 2 males) underwent auxiliary partial LDLT: 3 cases of APOLT and 2 cases of HAPLT. All of them received a small-for-size graft: graft-to-recipient weight ratio (GRWR) < or = 1.0%. The etiologies of FHF were hepatitis B virus (HBV) in 1, Wilson's disease in 1, and unknown origin in 3 cases. Three were the acute type and 2 the subacute type of FHF. Median age was 45 years (range, 14-54 years). Blood type was identical in all cases. A left lobe graft was used in 4 instances and a right lobe graft in 1 case. Median GRWR was 0.74 (range, 0.42-0.85). Median follow-up was 42 months (range, 3 days to 70 months). Three of 5 patients (60%) were alive (at 42, 67, and 70 months) and 1 was free of immunosuppression after sufficient recovery of the native liver. Two cases succumbed: 1 at postoperative day 3 because of cytomegalovirus pneumonia and 1 at 10 months after APOLT because of sepsis. Complications were seen in all 5 patients: Relaparotomy for hemostasis in 3, decompression surgery of the abdominal cavity in 1, rehepaticojejunostomy in 1, and biliary strictures in 2 cases. Auxiliary partial LDLT may be a choice as an aid for a small-for-size graft in FHF.
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Affiliation(s)
- T Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Oya H, Sato Y, Yamamoto S, Kobayashi T, Watanabe T, Kokai H, Hatakeyama K. De novo autoimmune hepatitis after living donor liver transplantation in a 25-day-old newborn baby: a case report. Transplant Proc 2009; 41:433-4. [PMID: 19249573 DOI: 10.1016/j.transproceed.2008.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 10/29/2008] [Indexed: 01/23/2023]
Abstract
De novo autoimmune hepatitis (AIH) has been described recently as a new type of graft dysfunction in pediatric patients receiving liver transplantation. Herein we have reported the case of a boy, diagnosed as neonatal hemochromatosis, who received a reduced left lateral graft 25 days after birth. Pretransplantation autoantibodies and serological tests were negative. The postoperative course was smooth. No episode of vascular or biliary complication or acute cellular rejection was observed. The maintenance immunosuppressant was tacrolimus only. Liver dysfunction occurred 13 months after living donor liver transplantation. Liver biopsies showed no acute cellular rejection, but severe apoptosis and regeneration of liver cells at the centrolobular area. At that time, various autoantibodies including anti-nuclear, anti-double-stranded DNA, and anti-smooth muscle antibodies were positive. In addition, serum immunoglobulin G (IgG) was elevated. Based on these findings, he was diagnosed as de novo AIH. The treatment consisted of reducing the tacrolimus dose and reintroduction of steroids. After 12 months of treatment, liver dysfunction improved, serum autoantibodies became negative, and serum IgG level normalized. Currently his immunosuppressive therapy consists of low-dose tacrolimus and prednisolone. In conclusion, the present case demonstrated that de novo AIH can appear in living donor liver transplant patients despite appropriate immunosuppression. Reducing the tacrolimus dose and reintroduction of prednisolone sustained the graft and prevented retransplantation.
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Affiliation(s)
- H Oya
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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36
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Kobayashi T, Sato Y, Shioji K, Yamamoto S, Oya H, Hara Y, Watanabe T, Kokai H, Hatakeyama K. Early regular examination of biliary strictures by endoscopic retrograde cholangiography for duct-to-duct biliary reconstruction after adult living donor liver transplantation. Transplant Proc 2009; 41:268-70. [PMID: 19249532 DOI: 10.1016/j.transproceed.2008.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 10/03/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
Abstract
In September 2006, we initiated regular screening of biliary strictures (BS) by endoscopic retrograde cholangiography (ERC) within 6 months after removal of external stents among duct-to-duct biliary reconstructed adult living donor liver transplantations (LDLT). From March 2000 to January 2008, we retrospectively evaluated 45 primary adult LDLTs who had survived >1 month. We separated the cases into 2 groups-the early cases (March 2000 to August 2006: n = 34) and the late cases (September 2006 to January 2008: n = 11)-to compare the incidences of BS and the success rates of endoscopic treatments. Median follow-up of the late cases (8.0 months) was shorter than that of the early cases (38.5 months; P = .0003). The overall incidence of BS was 36% (16/45), with 32% (11/34) among the early and 45% (5/11) among the late cases (P = .18). BS was successfully treated by endoscopic management in 4/5 (80%) late cases and 3/11 (27%) early cases (P = .049). Two early patients required operative biliary reconstructions. Endoscopic procedure-related complications developed in 2 patients among the early cases. Early postoperative regular screening of BS by ERC for duct-to-duct biliary reconstructions may be effective to avoid surgical interventions after adult LDLT. However, repeat ERCs have a risk for pancreatitis and other complications. Further investigations and longer follow-up are needed to confirm the efficacy and safety of a regular examination by ERC for duct-to-duct biliary reconstructions in LDLT.
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Affiliation(s)
- T Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Oya H, Sato Y, Yamamoto S, Nakatsuka H, Kobayashi T, Watanabe T, Hara Y, Kokai H, Hatakeyama K. Impact of intraportal donor-specific leukocyte transfusion for adult ABO-incompatible liver transplantation. Transplant Proc 2009; 41:222-5. [PMID: 19249519 DOI: 10.1016/j.transproceed.2008.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We have reported that repeated donor-specific leukocyte transfusions (DSLT) via the portal vein allow rapid reduction of immunosuppressants and decrease the occurrence of acute cellular rejection. Herein, we examined the immunological benefits of DSLT in adult ABO-incompatible living donor liver transplantation (LDLT). MATERIALS AND METHODS Ten adult patients (MELD score, 19.4 +/- 7.3; range, 12-29) underwent LDLT from ABO-incompatible donors from August 2003 to November 2007. The antirejection therapy included multiple perioperative plasmaphereses, splenectomy, and quadruple immunosuppression. In addition to these conventional approaches, we performed 4 intraportal administrations of DSLT after transplantation. RESULTS There was no humoral rejection in any patient. Two patients experienced mild cellular rejection requiring steroid pulse therapy. Both donor-specific immunoglobulin (Ig)M and IgG A/B antibodies in all patients decreased following transplantation by 16 fold. By flow cytometry, donor type of CD56+NK T cells existed in the liver graft showing macrochimerism at 1 month after liver transplantation. Furthermore, interleukin (IL)-10 production of Th2 type cytokines was up-regulated after transplantation. Three patients died of sepsis and infection. The 5-year survival rate was 70% by the Kaplan-Meier method. CONCLUSION Adult ABO-incompatible liver transplantation can be performed with acceptable patient and graft survival rates with a low risk of antibody-mediated rejection using intraportal administration of DSLT. Donor type CD56+NK T cells may induce tolerance by a veto or an anti-idiotype network mechanism.
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Affiliation(s)
- H Oya
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Kobayashi T, Sato Y, Yamamoto S, Oya H, Hara Y, Watanabe T, Kokai H, Hatakeyama K. Long-Term Follow-up Study of Biliary Reconstructions and Complications After Adult Living Donor Liver Transplantation: Feasibility of Duct-to-Duct Reconstruction With a T-Tube Stent. Transplant Proc 2009; 41:265-7. [DOI: 10.1016/j.transproceed.2008.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 10/29/2008] [Indexed: 11/29/2022]
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Kobayashi T, Sato Y, Yamamoto S, Oya H, Takeishi T, Kokai H, Hatakeyama K. Temporary cardiac pacing for fatal arrhythmia in living-donor liver transplantation: three case reports. Transplant Proc 2008; 40:2818-20. [PMID: 18929869 DOI: 10.1016/j.transproceed.2008.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cardiac pacing often turns out to be the only effective treatment of severe, life-threatening arrhythmias. We performed 77 living-donor liver transplantations (LDLT) from 1999 to 2007. In these cases, three recipients experienced fatal arrhythmia and required temporary cardiac pacing during the perioperative period. The first case was a 68-year-old woman diagnosed with liver cirrhosis and hepatocellular carcinoma (HCC). Her Model for End-Stage Liver Disease (MELD) score was 34. We performed LDLT using a right lobe graft. She showed complete atrioventricular block with cardiac arrest at postoperative day (POD) 42 after a bacterial infection. We performed a resuscitation and instituted temporary cardiac pacing. However, she was dead at POD 43. Pathologic findings at autopsy showed a diffuse myocardial abscess, which caused the fatal arrhythmia. The second case was a 58-year-old man diagnosed with HCC and liver cirrhosis; his MELD score was 9. We performed LDLT using a right lobe graft. He showed atrial fibrillation after septic shock. He also showed sinus bradycardia with a cardiac arrest at POD 10. We performed resuscitation and emergent temporary pacing. He recovered and was alive without recurrence of arrhythmia or infection. The third case was a 58-year-old woman diagnosed with multiple HCC. During preoperative regular check-up, she was diagnosed to have cardiac hypertrophy and was started on beta-blockers as treatment for cardiac hypertrophy. However, severe bradycardia necessitated temporary cardiac pacing. LDLT was performed safely after implantation of a pacemaker. Early use of temporary cardiac pacing for severe arrhythmias may be effective to maintain the hemodynamic state in LDLT.
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Affiliation(s)
- T Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of medical and Dental Sciences, Niigata, Japan
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40
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Oya H, Sato Y, Yamamoto S, Nakatsuka H, Kobayashi T, Watanabe T, Kokai H, Hatakeyama K. Thrombotic microangiopathy after ABO-incompatible living donor liver transplantation: a case report. Transplant Proc 2008; 40:2549-51. [PMID: 18929797 DOI: 10.1016/j.transproceed.2008.07.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Thrombotic microangiopathy (TMA) has rarely been reported in the setting of liver transplantation. Herein we have reported a successful case of TMA after ABO-incompatible living donor liver transplantation (LDLT) treated with plasma exchange and high-dose intravenous gamma-globulin infusion. A 50-year-old woman was diagnosed with hepatitis C virus-related cirrhosis. We performed an ABO-incompatible LDLT (group B to O) with preoperative plasma exchange to reduce the anti-B hemagglutinin titers to 1:8. The immunosuppressants consisted of tacrolimus, mycophenolate mofetil, and steroid. On postoperative day (POD) 8, her anti-B hemagglutinin titer suddenly increased to 1:64. The serum lactate dehydrogenase (LDH) level was grossly elevated (1518 IU/L). On POD 13, we suspected infection of an intra-abdominal hematoma (Serratia marcescens) which was drained surgically. On day 5 after the reoperation, thrombocytopenia developed with a platelet count of 3 x 10(4)/mm3. A peripheral blood film showed severe red blood cell (RBC) fragmentation. Thus, we made a clinical diagnosis of TMA and reduced the tacrolimus dose. We started intensive daily plasma exchange (4 L/d) with fresh frozen plasma and high-dose intravenous gamma-globulin infusions. One week thereafter, thrombocytopenia improved with reduced transfusion requirements. The peripheral blood film showed normal RBC morphology. The serum LDH returned to baseline levels. Four factors were considered to have caused TMA in this case: the prescription of tacrolimus, ABO-incompatible liver transplantation, bacterial infection, and surgical stress. These factors may have all contributed by causing significant endothelial injury and TMA.
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Affiliation(s)
- H Oya
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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41
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Kokai H, Sato Y, Yamamoto S, Oya H, Nakatsuka H, Watanabe T, Takizawa K, Hatakeyama K. Successful super-small-for-size graft liver transplantation by decompression of portal hypertension via splenectomy and construction of a mesocaval shunt: a case report. Transplant Proc 2008; 40:2825-7. [PMID: 18929872 DOI: 10.1016/j.transproceed.2008.08.080] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We performed a successful super-small-for-size graft liver transplantation by decompressing portal hypertension via splenectomy and a mesocaval shunt. A 46-year-old woman with Child-Pugh class C liver cirrhosis associated with Wilson's disease underwent a living donor liver transplantation (LDLT). The donor had an anomalous portal vein, hepatic vein, and bile duct, so we had to use the right lateral segment for the graft. Preoperative computed tomographic (CT) volumetry showed the volume of this area to be 433 mL; graft-to-recipient weight ratio (GRWR) was 0.72; and graft-to-standard liver volume (GV/SLV) was 39.0%. However, the real volume of the resected right lateral segment was 281 g; GRWR was 0.47; and GV/SLV was 25.3%--a super-small-for-size graft. After implantation, congestion of the small graft was severe due to excessive portal hypertension. Therefore, we tried decompressing the portal vein. First, we performed splenectomy which reduced the portal pressure which remained excessive. Second, a mesocaval shunt was constructed decreasing the portal pressure from 38 to 30 cm H2O. Additionally, we initiated continuous portal injection of prostaglandin E1. The postoperative course was not smooth, but the general status slowly recovered. Over 25 cm H2O of portal hypertension was observed until postoperative day 21 when it improved. At last, the recipient was discharged on postoperative day 156. Accurate preoperative CT volumetry is important to obtain sufficient graft volume. Our case may be one of the smallest-for-size grafts that was successfully transplanted. Management of excessive portal hypertension is important for LDLT, especially using a small-for-size graft. Splenectomy and construction of a mesocaval shunt may be useful strategies to decompress the portal vein.
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Affiliation(s)
- H Kokai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Sato Y, Yamamoto S, Oya H, Nakatsuka H, Kobayashi T, Watanabe T, Hara Y, Kokai H, Hatakeyama K. Adult ABO-incompatible liver transplantation by intraportal transfusion of donor-specific antigen: a case report. Transplant Proc 2008; 40:2811-4. [PMID: 18929867 DOI: 10.1016/j.transproceed.2008.08.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 55-year-old-woman suffering from fluminant hepatitis owing to autoimmune hepatitis underwent ABO-incompatible liver transplantation (LRLD) of blood type A to B. In this study, we investigated whether a new immunosuppressive strategy by intraportal transfusion of donor-specific leukocytes (DSLT) separated from whole blood would yield immunological benefit in adult ABO-LRLD. The operative course was uneventful; she was discharged at 46 days postoperatively without humoral or cellular rejection. On immunologic analysis, 54.6% intrahepatic macrochimerism of donor type CD56+ T cells was recognized at 1 month after transplantation. The interleukin-10 Th2 cytokine level was increased on postoperative day 1. Adult ABO-incompatible liver transplantation can be performed with acceptable patient and graft survival rates with a low risk of antibody-mediated rejection with our strategy of immunosuppression by intraportal administration of DSLT. Donor type CD56+ NKT cells may induce tolerance by a veto mechanism and/or an anti-idiotype network. ABO-incompatible liver transplantation may be improved by this strategy.
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Affiliation(s)
- Y Sato
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan.
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Sato Y, Nakatsuka H, Yamamoto S, Oya H, Kobayashi T, Watanabe T, Kokai H, Kenmochi T, Hatakeyama K. Living related pancreas transplantation alone with enteric drainage in Japan: case report. Transplant Proc 2008; 40:2559-61. [PMID: 18929800 DOI: 10.1016/j.transproceed.2008.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this study, we report a living donor partial pancreas transplantation using intraportal donor-specific leukocyte transfusion (DSLT). The recipient was a 38-year-old woman who had type I diabetes mellitus for 17 years. Hypoglycemia occurred 2 or 3 times per week. Her hemoglobin A1c level was 9.0%, and she required 70 U of insulin almost every day. The donor was her 64-year-old father. The steroid-minimized immunosuppressive protocol included 1.5mg of thymoglobulin administered with a steroid bolus on days 0, 4, and 7 postoperatively. Steroids were never prescribed thereafter. Postoperative maintenance therapy included tacrolimus (FK506) and mycophenolate mofetil. In addition to these conventional approarches, we administered intraportal DSLT on days 0, 1, 4, and 7 after transplantation. The donor-specific leukocytes (40mL) had been separated from donor whole blood using an apheresis filter (Cellsorba EX; Asahi Kasei medical Co, Ltd, Tokyo, Japan). In the recipient operation, a segmental pancreas graft was transplanted into the right iliac cavity with enteric drainage with a pancreatic duct stent. Operation time was 6 hours. The postoperative course was uneventful. The patient was discharged on day 15 after transplantation. There was no acute rejection for six months after transplantation. The hemoglobin A1c level recovered to 5.1% with 6 U of insulin per day. At immunologic analysis, only interleukine-10 cytokine production was elevated at 7 days after transplantation. At flow cytometry cross-match analysis, the immunoglobulin M antibody decreased from day 7 after transplantation. We conclude that intraportal DSLT may be an effective adjunct to a steroid-free regimen.
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Affiliation(s)
- Y Sato
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan.
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Kobayashi T, Sato Y, Yamamoto S, Oya H, Kokai H, Kurosaki I, Hatakeyama K. Successful Management of a Type 2 Diabetic Donor in Living-Donor Liver Transplantation: A Case Report. Transplant Proc 2008; 40:2842-3. [DOI: 10.1016/j.transproceed.2008.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Reale RA, Calvert GA, Thesen T, Jenison RL, Kawasaki H, Oya H, Howard MA, Brugge JF. Auditory-visual processing represented in the human superior temporal gyrus. Neuroscience 2007; 145:162-84. [PMID: 17241747 DOI: 10.1016/j.neuroscience.2006.11.036] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 11/06/2006] [Accepted: 11/08/2006] [Indexed: 11/28/2022]
Abstract
In natural face-to-face communication, speech perception utilizes both auditory and visual information. We described previously an acoustically responsive area on the posterior lateral surface of the superior temporal gyrus (field PLST) that is distinguishable on physiological grounds from other auditory fields located within the superior temporal plane. Considering the empirical findings in humans and non-human primates of cortical locations responsive to heard sounds and/or seen sound-sources, we reasoned that area PLST would also contain neural signals reflecting audiovisual speech interactions. To test this hypothesis, event related potentials (ERPs) were recorded from area PLST using chronically implanted multi-contact subdural surface-recording electrodes in patient-subjects undergoing diagnosis and treatment of medically intractable epilepsy, and cortical ERP maps were acquired during five contrasting auditory, visual and bimodal speech conditions. Stimulus conditions included consonant-vowel (CV) syllable sounds alone, silent seen speech or CV sounds paired with a female face articulating matched or mismatched syllables. Data were analyzed using a MANOVA framework, with the results from planned comparisons used to construct cortical significance maps. Our findings indicate that evoked responses recorded from area PLST to auditory speech stimuli are influenced significantly by the addition of visual images of the moving lower face and lips, either articulating the audible syllable or carrying out a meaningless (gurning) motion. The area of cortex exhibiting this audiovisual influence was demonstrably greater in the speech-dominant hemisphere.
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Affiliation(s)
- R A Reale
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA.
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Oya H, Sato Y, Yamamoto S, Nakatsuka H, Kobayashi T, Hara Y, Waguri N, Suda T, Aoyagi Y, Hatakeyama K. Comparison between human-telomerase reverse transcriptase mRNA and alpha-fetoprotein mRNA as a predictive value for recurrence of hepatocellular carcinoma in living donor liver transplantation. Transplant Proc 2006; 38:3636-9. [PMID: 17175353 DOI: 10.1016/j.transproceed.2006.10.172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In this study we compared the potential roles of preoperative human-telomerase reverse transcriptase (h-TERT) mRNA versus alpha-fetoprotein (AFP) mRNA expression in the peripheral blood as a tool to predict prognosis and tumor recurrence after living donor liver transplantation (LDLT) in hepatocellular carcinoma (HCC) patients. PATIENTS AND METHODS We examined 14 patients with unresectable HCC who underwent LDLT. Six patients displayed stage IVA HCC that deviated from the Milan criteria, while the rest of the patients fell within the limitations of the Milan criteria. We analyzed the relationship between preoperative h-TERT mRNA or AFP mRNA expression in the peripheral blood and survival without recurrence. RESULTS There was no significant difference between the survival curves without recurrence of those patients who did versus did not meet the Milan criteria. There was also no significant difference between the survival curves without recurrence among patients with positive versus negative AFP mRNA expression. However, there was a significant difference (P = .005) between the survival curves without recurrence of those patients with positive preoperative h-TERT mRNA expression versus those who either had an initially negative preoperative h-TERT mRNA or who converted from positive to negative after neoadjuvant immunochemotherapy. CONCLUSIONS h-TERT mRNA seemed to prove more valuable than AFP mRNA not only to assess preoperative treatment modalities and postoperative patient surveillance, but also to evaluate prospective LDLT patients with HCC. Moreover, use of h-TERT mRNA could potentially expand the indications for transplantation to patients outside the Milan criteria.
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Affiliation(s)
- H Oya
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Sato Y, Watanabe H, Kameyama H, Kobayashi T, Yamamoto S, Takeishi T, Hirano K, Oya H, Nakatsuka H, Watanabe T, Kokai H, Yamagoe S, Suzuki K, Oya K, Kojima K, Hatakeyama K. Serum LECT2 level as a prognostic indicator in acute liver failure. Transplant Proc 2005; 36:2359-61. [PMID: 15561249 DOI: 10.1016/j.transproceed.2004.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the present study, we investigated the relationship between serum leukocyte cell-derived chemotaxin2 (LECT2) levels and liver function in patients with acute liver failure, and its use as a prognostic indicator. We studied six acute liver failure patients (two women, four men; 49.8 +/- 20.7 years old) admitted to our hospital in 2002. These patients had diagnoses of fulminant hepatitis due to acute liver failure (1) from congestive heart failure; (2) from portal venous gas, and (3) from postoperative disseminated intravascular coagulation (DIC). We measured serum LECT2, GOT, and GPT levels, the last two being inversely proportionate to the serum LECT2 levels. When the serum GPT levels peaked, the serum LECT2 levels were the lowest. When the liver function recovered, serum LECT2 levels increased. Three of four patients died due to liver failure, one to congestive heart failure. Maximum serum LECT2 levels among the expired group were significantly lower than those among the alive group (0.96 +/- 0.8 ng/mL vs 12.9 +/- 4.3 ng/mL). Serum LECT2 levels may be a prognostic indicator of recovery from liver failure. The present study suggests that in clinical medicine LECT2 participates in regeneration after injury of hepatocytes.
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Affiliation(s)
- Y Sato
- Department of Regenerative and Transplant Medicine, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences Niigata, Japan.
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Sato Y, Watanabe H, Kameyama H, Kobayashi T, Yamamoto S, Takeishi T, Hirano K, Oya H, Nakatsuka H, Watanabe T, Kokai H, Yamagoe S, Suzuki K, Oya K, Kojima K, Hatakeyama K. Changes in serum LECT 2 levels during the early period of liver regeneration after adult living related donor liver transplantation. Transplant Proc 2005; 36:2357-8. [PMID: 15561248 DOI: 10.1016/j.transproceed.2004.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We investigated changes in serum leukocyte cell-derived chemotaxin2 (LECT2) levels between donors and recipients in the early period during liver regeneration following adult living related donor liver transplantation (LRDLT). Five recipients (three women, two men; 37.0 +/- 15.8 years old), all of whom had end-stage liver failure, underwent LRDLT from healthy five donors (two women, three men; 41.6 +/- 14.3 years old) between June 2000 and February 2001. FK506 and methylprednisolone were used as immunosuppressants for recipients. Serum LECT2 levels decreased immediately after both the hepatectomy in all donors and the implantation of liver graft in all recipients. Donors showed a nadir at 3 to 12 hours, increasing at 24 to 48 hours. The nadir in recipients occurred several hours after the donors. The serum LECT2 levels of donors were significantly higher than those of recipients on day 5 (9.5 +/- 5.9 ng/mL vs 3.1 +/- 2.2 ng/mL, P = .04) and on day 7 (9.3 +/- 3.8 ng/mL vs 3.5 +/- 1.1 ng/mL, P = .04). Serum GPT and GOT levels were inversely proportionate to the serum LECT2 levels. The present studies suggest that LECT2 participates in liver regeneration and injury following hepatectomy.
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Affiliation(s)
- Y Sato
- Department of Regenerative and Transplant Medicine, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Oya H, Sato Y, Yamamoto S, Takeishi T, Kobayashi T, Hatakeyama K. Living related donor liver transplantation for primary sclerosing cholangitis with hepatocellular carcinoma and Crohn's disease: a case report. Transplant Proc 2005; 36:2297-8. [PMID: 15561226 DOI: 10.1016/j.transproceed.2004.07.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Primary sclerosing cholangitis (PSC) is a premalignant condition associated with a risk of developing cholangiocarcinoma in 10% to 20% of patients. However, the prevalence of hepatocellular carcinoma (HCC) in patients with PSC is estimated to be only 2%. In addition, PSC often occurs in association with inflammatory bowel disease. Ulcerative colitis occurs in 60% of PSC patients and Crohn's disease occurs in about 10%. We diagnosed a patient as having PSC with HCC and concomitant Crohn's disease prior to living related donor liver transplantation (LRDLT). PATIENTS AND METHODS A 63-year-old woman was diagnosed as having PSC with solitary HCC. Preoperative liver condition was Child-Pugh grade C. Colonoscopic findings showed an active longitudinal ulcer in the terminal ileum and clinically diagnosed Crohn's disease. The medical treatment was 5'-aminosalicylates. She received a left lobe graft from her daughter. The immunosuppressants were tacrolimus and azathioprine, which was changed to predonisolone because of leukopenia and moderate acute cellular rejection, after which the postoperative course was uneventful. Colonoscopic findings revealed disappearance of the longitudinal ulcer in the terminal ileum at 15 months after LRDLT. There was no evidence of PSC or HCC recurrence. CONCLUSIONS Generally, PSC with HCC is rare with a poor prognosis; however, LRDLT may be a treatments option although the patient with PSC had a combined HCC. Moreover, aminosalicylates together with the immunosuppressants may be effective for the clinical management of concomitant Crohn's disease.
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Affiliation(s)
- H Oya
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Kobayashi T, Sato Y, Yamamoto S, Takeishi T, Oya H, Nakatsuka H, Watanabe T, Hatakeyama K. Biliary reconstruction and complications of left lobe living donor liver transplantation. Transplant Proc 2005; 37:1122-3. [PMID: 15848642 DOI: 10.1016/j.transproceed.2004.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postoperative biliary tract complications remain one of the most serious problems facing patients who undergo living donor liver transplantation. The aim of this study was to analyze the clinical implications of three methods of biliary reconstruction in left lobe adult living donor liver transplantation. We retrospectively compared three groups of patients who underwent various biliary reconstructions: those who had Roux-en-Y hepaticojejunostomy (HJ) (n = 11); duct to duct hepaticohepaticostomy (HH) with an external stent (n = 11); or HH with T-tube (n = 6). The median follow-up for each group was 29, 28, and 8 months, respectively. Bile leaks were observed in 45.5% of both the HJ and the HH with external stent groups. Biliary anastomotic strictures occurred in 9.1% of the Roux-en-Y HJ patients and in 27.2% of those who had HH with an external stent. No biliary complications were observed in the HH over a T-tube group (P = .049). Biliary reconstruction using HH with a T-tube may decrease the incidence of biliary complications. Despite the relatively short follow-up, these encouraging preliminary results warrant further studies of this biliary reconstruction technique for left lobe adult living donor liver transplantations.
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Affiliation(s)
- T Kobayashi
- Graduate School of Medical and Dental Sciences, Division of Digestive and General Surgery, Nigata University, 1757-Asahimachi-dori, 951-8510, Nagata, Japan
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